The definition of delay in transfer of care is subjective
EDITOR-Crotty et al based their definition of delayed discharge in
the trial of transitional care services on the grounds that patients were
medically stable and ready for discharge1. The designation of delayed
discharge depends on clinical judgement and is therefore subjective and
may lack standardisation. We have recently undertaken a study to
investigate the clinical opinion of colleagues involved in the discharge
process locally on a single adapted clinical scenario of an elderly in-
patient with medical and mental health needs.
Respondents (n=31 out of 50) to the case-scenario questionnaire were
asked:
a. Was this case a delayed transfer of care?
b. If so when and for what reason were they a delay in transfer of
care?
5 persons stated that the case was at no time a delayed transfer of
care. The remainder (26) identified the patient as a delayed transfer of
care and showed a broad range in their interpretation of timing of delayed
discharge (range 2-15 days out of potential 0-16 days, median 10.5 days,
Interquartile range 9-12). There was poor agreement as to the reason for a
delayed discharge under the categories of ‘healthcare assessment,
healthcare arrangements, social or other’, and even if respondents shared
the same estimation of day of discharge (only 6 respondents agreed on both
timing and reason for delay).
Crotty et al experienced similar difficulties in accurately
identifying readiness for discharge to long term care with 7.3% of their
sample discharged home and may therefore have been inappropriately
classified as a delay in transfer of care. Both studies highlight the
difficulty in clarification of delayed transfer of care which needs to be
addressed in the methodology of future research in this area.
The high mortality of patients defined as a delay in discharge by
Crotty et al (27-28% of patients at 4 months)
illustrates that therapeutic opportunities may be missed if the label of
transfer of care is applied too early or inappropriately.
1 Crotty M, Whitehead C, Wundke R. Transitional care facility for
elderly people in hospital awaiting a long term care bed: randomised
controlled trial. BMJ 2005; 331:1110-3.
Competing interests:
None declared
Competing interests:
No competing interests
18 November 2005
Eamonn M Eeles
Specialist Registrar Care of the Elderly Medicine
Karl Davis, Praveen Pathmanaban, Rhian Morse
Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant. CF728XR
Rapid Response:
The definition of delay in transfer of care is subjective
EDITOR-Crotty et al based their definition of delayed discharge in
the trial of transitional care services on the grounds that patients were
medically stable and ready for discharge1. The designation of delayed
discharge depends on clinical judgement and is therefore subjective and
may lack standardisation. We have recently undertaken a study to
investigate the clinical opinion of colleagues involved in the discharge
process locally on a single adapted clinical scenario of an elderly in-
patient with medical and mental health needs.
Respondents (n=31 out of 50) to the case-scenario questionnaire were
asked:
a. Was this case a delayed transfer of care?
b. If so when and for what reason were they a delay in transfer of
care?
5 persons stated that the case was at no time a delayed transfer of
care. The remainder (26) identified the patient as a delayed transfer of
care and showed a broad range in their interpretation of timing of delayed
discharge (range 2-15 days out of potential 0-16 days, median 10.5 days,
Interquartile range 9-12). There was poor agreement as to the reason for a
delayed discharge under the categories of ‘healthcare assessment,
healthcare arrangements, social or other’, and even if respondents shared
the same estimation of day of discharge (only 6 respondents agreed on both
timing and reason for delay).
Crotty et al experienced similar difficulties in accurately
identifying readiness for discharge to long term care with 7.3% of their
sample discharged home and may therefore have been inappropriately
classified as a delay in transfer of care. Both studies highlight the
difficulty in clarification of delayed transfer of care which needs to be
addressed in the methodology of future research in this area.
The high mortality of patients defined as a delay in discharge by
Crotty et al (27-28% of patients at 4 months)
illustrates that therapeutic opportunities may be missed if the label of
transfer of care is applied too early or inappropriately.
1 Crotty M, Whitehead C, Wundke R. Transitional care facility for
elderly people in hospital awaiting a long term care bed: randomised
controlled trial. BMJ 2005; 331:1110-3.
Competing interests:
None declared
Competing interests: No competing interests